The Menopause Treatment 98% of Women Aren't Using

A Mayo Clinic study shows awareness was never the bottleneck.

The entire menopause-care market rests on one assumption: that rising awareness converts into rising treatment, and that the companies sitting at that conversion point capture the upside. A Mayo Clinic study published June 1 in Mayo Clinic Proceedings finds the conversion is not happening.

Hormone therapy use among U.S. women fell from 4.4% in 2007 to 1.7% in 2023. Among women aged 50 to 59, the group with the most to gain, only 3.5% were using it in 2023. Researchers tracked prescription fills among women 40 and older across a national health database, counting only those with at least 180 days of filled prescriptions in a year. Use now sits at its lowest level since the early 2000s, when the Women's Health Initiative trial set off the original decline.

Awareness was supposed to reverse that. It has climbed for a decade. Venture firms funded it, employers built benefits around it, and a generation of midlife-care platforms launched on the premise that the cultural moment would become a market. The treatment data moved the other way. "We have strong evidence that hormone therapy is safe and effective for many women, but that hasn't translated into how it's used in clinical practice," said Dr. Stephanie Faubion, director of Mayo Clinic's Center for Women's Health and the study's author.

The barriers the researchers identify reorganize the investment thesis. They cite clinician misinformation, limited menopause training among physicians, and women who seek care for their symptoms but leave without a therapy that would help. None of those is a demand problem. Each one sits on the prescriber side of the transaction. That is where the category will be decided.

A platform that raises awareness is pushing a lever that has already moved. A platform that puts a trained prescriber in front of a symptomatic woman and sends her home with a filled prescription is solving the constraint the data names. Midi, Alloy, Elektra, and Evernow are not competing to make women aware of menopause. They are competing to convert that awareness into treatment, and this study measures how wide that gap still runs.

Use was consistently higher among white women than among Black, Hispanic, and Asian American women. The category's largest and least-served conversion problem is also its clearest commercial opening.